High-Sensitivity Troponin I and Amino-Terminal Pro-B–Type Natriuretic Peptide Predict Heart Failure and Mortality in the General Population

Study Questions:

What is the prognostic utility of a novel cardiac troponin I (cTnI) high-sensitivity assay, independently and in combination with amino-terminal pro–B-type natriuretic peptide (NT-proBNP), to predict development of heart failure (HF) in the future and mortality in the general population?


The study cohort was comprised of 2,042 participants who underwent clinical assessment and echocardiographic evaluation. The investigators obtained baseline measurements of cTnI with a high-sensitivity assay and NT-proBNP in 1,843 individuals. The study investigators followed participants for new-onset HF and mortality, with median (25th, 75th percentile) follow-up of 10.7 (7.9, 11.6) and 12.1 (10.4, 13.0) years, respectively.


The study investigators found that the high-sensitivity cTnI greater than the gender-specific 80th percentile was independently predictive of HF (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.88-3.50; p < 0.001) and mortality (HR, 1.91; 95% CI, 1.49-2.46; p < 0.001) beyond conventional risk factors, with significant increases in the net reclassification improvement for HF. Although the prognostic utility of high-sensitivity cTnI went beyond NT-proBNP, the findings of this study suggest that these two assays are complementary and most helpful when evaluated together in identifying at-risk individuals for HF.


The authors concluded that the utility of high-sensitivity cTnI can be used together with other biomarkers to aggressively prevent HF in the general population.


This is an important study because it suggests that high-sensitivity cTnI can add incremental value to measurements of NT-proBNP in predicting HF. The findings of this study now need to be validated in the general population, including the elderly and individuals from multi-ethnic backgrounds.

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